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Impact of Tumor Necrosis Factor Inhibitor Versus Nonsteroidal Antiinflammatory Drug Treatment on Radiographic Progression in Early Ankylosing Spondylitis: Its Relationship to Inflammation Control During Treatment
Author(s) -
Park Jun Won,
Kim Min Jung,
Lee Jeong Seok,
Ha YouJung,
Park Jin Kyun,
Kang Eun Ha,
Lee Yun Jong,
Song Yeong Wook,
Lee Eun Young
Publication year - 2019
Publication title -
arthritis and rheumatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.106
H-Index - 314
eISSN - 2326-5205
pISSN - 2326-5191
DOI - 10.1002/art.40661
Subject(s) - medicine , ankylosing spondylitis , tumor necrosis factor alpha , spondylitis , gastroenterology , confidence interval , inflammation , nonsteroidal , c reactive protein , surgery , tumor necrosis factor α
Objective To investigate the impact of tumor necrosis factor inhibitor ( TNF i) treatment and inflammation control on radiographic progression in early ankylosing spondylitis ( AS ) over 4 years. Methods We included a total of 215 patients with early AS (symptom duration <10 years) treated with TNF i (the TNF i group; n = 135) or with nonsteroidal antiinflammatory drugs ( NSAID s) (the control group; n = 80). Two blinded readers assessed radiographic progression using the modified Stoke Ankylosing Spondylitis Spine Score ( mSASSS ). Inflammation control was inferred from C‐reactive protein ( CRP ) levels time‐averaged between 2 radiologic assessments. Linear mixed modeling was used to estimate mSASSS changes over radiographic intervals as well as the impact of clinical factors on outcomes. Results The TNF i group had longer disease duration, a higher baseline CRP level, and a higher Bath Ankylosing Spondylitis Disease Activity Index than did controls. The time‐averaged CRP level over radiographic intervals was lower with TNF i treatment than with NSAID treatment (mean ± SD 0.27 ± 0.30 mg/dl versus 0.61 ± 0.68 mg/dl; P < 0.001). Overall, mean ± SD mSASSS change over the 2‐year interval was 1.30 ± 2.97 units. In the multivariable model adjusted for age, smoking status, baseline CRP level, and the presence of syndesmophytes at baseline, the TNF i group showed less mSASSS change over the 2‐year interval (β = −0.90 [95% confidence interval {95% CI } −1.51, −0.29]). However, when a time‐averaged CRP level was additionally included, it significantly influenced the mSASSS change (β = 1.02 [95% CI 0.32, 1.71]), decreasing the estimated group difference (β = −0.52 [95% CI −1.17, 0.14]). NSAID indices of both groups were not associated with either time‐averaged CRP levels or mSASSS changes. Conclusion Effective suppression of inflammation by TNF i treatment decreases radiographic progression in early AS .